Citizen Complaint Form

This form has been modified since it was saved. Please review all fields before submitting.

YOUR INFORMATION

Please provide your contact information.

Name*

D.O.B.

Address*

Best Phone Number to Call

Best Time to Call

Email Address

WITNESS INFORMATION

Please provide contact information for any witnesses.

Name

Address

Phone Number

Name

Address

Phone Number

Name

Address

Phone Number

OFFICER / EMPLOYEE INFORMATION

Please provide the names of the officer(s) or employee(s) involved.

Name

Name

Name

Name

If you do not know the names of the employees or officers, please provide comments here:

INCIDENT DETAILS

Please provide information regarding the incident.

Date of Incident

Time of Incident

Case Number (if known)

Location of Incident (address or description)

Narrative (please provide a detailed summary of your complaint)

What is your desired outcome?

SIGNATURE AND ACKNOWLEDGEMENT

By signing this form, I acknowledge that the information I’ve provided is true and correct to the best of my knowledge. I understand that it is a criminal offense to make a false statement to a member of the police department, pursuant section 76-8-503 and/or 76-8-504, of the Utah Criminal Code. I understand that digital signatures are considered legal in the State of Utah.